Cheryl J. Cherpitel

As recreational cannabis legalization expands in the United States, concerns about cannabis-impaired driving and traffic injury risk have increased. Although cannabis impairs driving performance, less is known about how sex-specific behavioral and psychosocial contexts shape pathways to motor vehicle collisions (MVCs), particularly in legalized settings. We examined sex differences in cannabis and alcohol use, driving behaviors, mental health context, and crash-related outcomes among injured drivers. We conducted a secondary analysis of a multicenter cross-sectional study of 813 adults presenting to emergency departments in Denver, Portland, and Sacramento within 8 h of an MVC. Recent cannabis and alcohol use were identified using self-report and biological testing. Sex-specific differences in substance use, driving behaviors, mental health indicators, and clinical outcomes were evaluated using descriptive statistics. Recent cannabis use did not differ significantly between males and females (9% vs. 6%, p = 0.21), whereas alcohol use was higher among males (17% vs. 9%, p = 0.005). Male drivers more frequently engaged in high-risk driving behaviors, including higher reported speeds, use of open vehicles, and vehicle rollovers, and were more often admitted to the hospital (58% vs. 43%). Female drivers more commonly reported cannabis use for anxiety and a higher burden of posttraumatic stress symptoms (24% vs. 17%). Injury severity scores were similar between sexes. Similar prevalence of cannabis use among injured drivers concealed distinct sex-specific pathways to MVC risk. Among men, alcohol co-use and high-risk driving behaviors represented established mechanisms of crash severity and health-care utilization. Among women, cannabis use more often occurred within a mental health context, suggesting different pathways linking substance use to traffic injury risk. Traffic injury prevention strategies in legalized cannabis environments should incorporate sex- and gender-responsive approaches, including targeted interventions addressing polysubstance use and hazardous driving behaviors, and integration of mental health considerations into impaired-driving prevention.

Background: While alcohol is known to sensitize the pancreas to acute injury, the role of short‐term episodic drinking in regular drinkers is unknown. Methods: We conducted a case‐crossover study to (1) determine the hazardous period of drinking prior to a first episode of acute pancreatitis (FAP) or recurrent acute pancreatitis (RAP) and (2) evaluate the dose–response association between short‐term drinking and FAP/RAP. Patients hospitalized for FAP/RAP with an AUDIT‐C score of ≥3 were enrolled. Recent and lifetime drinking history were collected through interviews. Drinking prior to the index pancreatitis attack was compared to that of an asymptomatic control period. Conditional logistic regression quantified the association of heavy drinking and FAP/RAP. Results: Of 141 patients who completed a short‐term drinking questionnaire, 77 had RAP, and 64 experienced FAP. We found that both FAP and RAP patients drank at moderate‐to‐heavy levels regularly, with modest day‐to‐day variation (intraclass correlation of drinks/day 67%–82%). Alcohol consumption increased 2 days preceding the onset of the index pancreatitis attack as compared to the week prior. Stratifying by prior AP history, heavy drinking in the hazard period was associated with RAP (OR = 3.79, 95% confidence interval [CI] 1.57–9.12). Each drink was associated with 1.22‐fold (95%CI 1.10–1.35) increased odds of RAP. Short‐term heavy drinking was not associated with a FAP (OR = 1.06, 95%CI 0.43–2.57). Conclusion: In summary, we found that patients with a prior history of AP face a higher risk of RAP due to excess drinking. Drinking intensity did not increase prior to a FAP, which may have been triggered by other cofactors warranting further examination.

Objective: The association of many chronic disease conditions with alcohol consumption is well established, and research on drinking patterns following diagnosis suggests that those with a chronic condition drink less than their healthy counterparts. However, these studies have not controlled for confounding influences on this relationship. This article reports current drinking patterns of those with one of four chronic disease conditions (hypertension, diabetes, heart disease, cancer) compared to those without, controlling for covariates. Method: Data were analyzed from a merged sample of the two National Alcohol Surveys of the U.S. adult population (2014-2015 and 2019-2020; n = 9,597). Those reporting any one of the four disease conditions were matched to healthy control respondents on demographic characteristics and history of drinking using propensity score weighting (PSW). Results: Those with hypertension and heart disease appeared to drink less than controls during the last year, but after models were adjusted for covariates or PSW, no significant differences were found. For diabetes, only the PSW models showed no significant difference in drinking from controls, whereas both unadjusted and adjusted models for cancer showed no differences from controls. Conclusions: Controlling for covariates and PSW appeared to make cases and their healthy controls more similar in past-year drinking patterns. Observed similarity in drinking patterns of those with and without a chronic disease may serve as an impetus for a greater focus on screening and identification of those with chronic conditions who would benefit from focused harm-reduction messages and implementation of effective alcohol interventions.

This study assessed contributions of exposure to neighborhood stressors (violent victimization, witnessing crime, greater alcohol and drug availability) to variation in alcohol use disorder (AUD) symptoms among drinkers in three cities in Texas, USA. We used data from interviews conducted from 2011 to 2013 with Mexican-origin adults (ages 16–65) in the US-Mexico Study of Alcohol and Related Conditions who were past-year drinkers (N = 1960; 55% male) living in two cities in the Texas-Mexico border region (Laredo, n = 751 and Brownsville/McAllen, n = 814) and one interior comparison site (San Antonio, n = 771). Analyses (conducted in 2018 and 2019) examined overall and gender-stratified multilevel mediated effects of each border site (versus San Antonio) on AUD symptoms through the neighborhood-level factors, adjusting for individual- and neighborhood-level covariates. Overall, drinkers in Laredo reported more AUD symptoms than drinkers in the other cities, and their neighborhoods had more witnessing of crime and greater perceived drug availability, as well as higher levels of disadvantage and a lower proportion non-Hispanic White residents, than neighborhoods in San Antonio. Witnessing neighborhood crime was associated with increased AUD symptoms, while neighborhood disadvantage and proportion non-Hispanic White residents each were negatively associated with AUD symptoms. Perceived neighborhood insecurity, crime victimization, perceived neighborhood drug availability and neighborhood alcohol availability (off- and on-premise) were not significantly associated with AUD symptoms. Stratified models suggested possible gender differences in indirect effects through witnessing neighborhood crime. Reducing witnessing of neighborhood crime may help reduce AUD symptoms among adults living in the US border region.

Although Brief Intervention (BI) has proven to reduce alcohol consumption during pregnancy in high income countries, there is no evidence from the Southern Cone of America. Thus, we conducted a stu...

Aims: To estimate risk of injury associated with frequency of drinking and heavy drinking (5+ drinks on occasion) by gender and race/ethnicity in the US population. Methods: Data were from a merged sample of two National Alcohol Surveys (telephone and web-based) (2014–2015 and 2019–2020) on 16,639 respondents, and analyzed using Cox proportional hazards models with age as the timescale in a retrospective cohort design. Life-course drinking was determined by age of onset and questions on any drinking and heavy drinking by decade of life. The outcome measure was having had an injury from a serious accident at a certainage. Results: Frequent heavy drinking (5+ daily, weekly and monthly) was significantly predictive of injury with hazard ratios (HRs) of 2.40, 1.81 and 1.50, respectively, while frequent light drinking (alcohol at least weekly and 5+ yearly or less) was also significant for women (HR = 1.73). For White respondents, 5+ at least weekly was significant for both men (HR = 1.74) and women (HR = 2.42). Among Hispanic respondents, 5+ at least weekly and 5+ monthly were both significant for men (HR = 2.81 and 2.49, respectively) and women (HR = 2.81 and 3.48, respectively). Among Black women, risk was significant for 5+ monthly (HR = 2.90) and for any alcohol ≥ weekly (HR = 2.72), but neither frequency of any drinking or 5+ was significant for Blackmen. Conclusions: Data suggest a greater risk of injury from a serious accident for frequent heavy drinkers among all White and Hispanic respondents, and Black women, but not for Blackmen.

Background: Numerous studies of roadside accidents among emergency room patients show elevated risk of injury from acute alcohol consumption, i.e., recent drinking precedes the injury event. The observed effects are large and show a dose–response relationship. In contrast, studies quantifying the association between injury risk and chronic consumption, such as past‐year average volume, show lower relative risk estimates than those from acute consumption.Methods: Combining data from 4 waves of US National Alcohol Surveys (NAS) for years 2000–2015 (N = 29,571, 53% overall cooperation rate), we estimated the risk of any past‐year injury from past‐year volume using logistic regression. This was contrasted with an instrumental variable (IV) analysis utilizing a 2‐stage residual inclusion (2SRI) approach to estimate injury risk from volume, which adjusted for unobserved confounders using state beer and spirits tax rates, zip code‐level outlet and bar density, and control state status as instruments.Results: Based on the combined US population surveys and controlling for sociodemographics, using conventional logistic regression, the odds ratios of injury from an average volume of 1, 2, and 5 drinks per day were 1.12 [95% confidence interval: 1.02, 1.24], 1.10 [1.00, 1.22], and 1.04 [0.88, 1.22], respectively. These compared with 1.67 [1.00, 2.78], 2.38 [0.87, 6.54], and 6.98 [0.57, 85.89] using the IV method. The proportion of injury attributed to alcohol also increased in magnitude, from 6.2% [0.3%, 11.9%] using the conventional approach to 17.9% [8.2%, 27.7%] using the IV method.Conclusions: The association between injury and chronic alcohol consumption may be confounded by unobserved factors, resulting in a possible downward bias of the risk estimate.

Objectives. To analyze changes in racial/ethnic disparities for unintentional injury mortality from 1999-2016. Methods. Mortality data are from the National Center for Health Statistics (NCHS) for all unintentional injuries, analyzed separately by injury cause (motor vehicle accidents [MVA], poisonings, other unintentional) for white, black, and Hispanic populations within four age groups: 15-19, 20-34, 35-54, 55-74 for males and for females. Results. Rates across race/ethnic groups varied by gender, age and cause of injury. Unintentional injury mortality showed a recent increase for both males and females, which was more marked among males and for poisoning in all race/ethnic groups of both genders. Whites showed highest rates of poisoning mortality and the steepest increase for both genders, except for black males aged 55-74. MVA mortality also showed an increase for all race/ethnic groups, with a sharper rise among blacks, while Hispanics had lower rates than either whites or blacks. Rates for other unintentional injury mortality were similar across groups except for white women over 55, for whom rates were elevated. Conclusions. Data suggest while mortality from unintentional injury related to MVA and poisoning is on the rise for both genders and in most age groups, blacks compared to whites and Hispanics may be suffering a disproportionate burden of mortality related to MVAs and to poisonings among those over 55, which may be related to substance use.

Objective. To report demographic and substance use characteristics and risk of road traffic injury (RTI) from alcohol use, cannabis use, and combined use in a sample of emergency department patients from two countries in Latin America and the Caribbean. Methods. A cross-sectional study in which patients 18 years and older admitted within six hours of suffering an RTI to one emergency department in Santa Domingo, Dominican Republic (n = 501) and in Lima, Peru (n = 431) were interviewed. Case-crossover analysis, based on self-reported use prior to the RTI, was used to analyze risk from alcohol, cannabis, and co-use. Results. Overall, 15.3% reported alcohol use prior to the event and 2.5% cannabis use. Drivers using alcohol only were over twice as likely to have an RTI (OR = 2.46, p < 0.001), and nearly eight times more likely if using both alcohol and cannabis (OR = 6.89, p < 0.01), but risk was not elevated for cannabis alone. Significant differences were not found for passengers or pedestrians. Conclusions. Risk of RTI for drivers in these two samples is significantly elevated from alcohol use, and more so for co-use with cannabis. Differences between the two countries underscore the need for similar data from the region to determine risk of RTI from substance use, including risk for passengers and pedestrians. Data suggest that alcohol contributes significantly to the burden of RTI, which calls for more stringent enforcement of alcohol control policy related to drink driving in the region.